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Occupational attainment is an important determinant of well-being, yet it has received relatively little attention in the immigrant health literature. Despite increasing educational heterogeneity among immigrants, we know little about the degree to which their occupational trajectories - including experiences of education-occupation mismatch and unemployment/economic inactivity - are associated with changes in health status over time. Drawing on longitudinal data from the 2014 Survey of Income and Program Participation, we investigate the health consequences of education-occupation mismatch and unemployment/economic inactivity across nativity (i.e., U.S. born or immigrant) and education groups. Findings suggest that vertical mismatch (i.e., undermatch and overmatch) and unemployment/economic inactivity contribute to poorer self-rated health over time, with the strongest effect magnitudes observed for overmatch and unemployment/economic inactivity, respectively. We do not find a nativity disparity in the health consequences of vertical mismatch, but we do identify that unemployment/economic inactivity is less consequential for the health of immigrants compared to the U.S. born. Additionally, among respondents with at least a college education, we find that both overmatch and unemployment/economic inactivity are less detrimental to the health of immigrants than to the health of the U.S. born. Together, our findings suggest that although occupational trajectories may be a salient force shaping health generally, they may be less relevant to the health of immigrants. Policies aimed at improving job alignment could have important implications for the health of not only immigrants, but the entire U.S. population.